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Lésions maculaires causées par des pointeurs laser. Résolution spontanée ou traitement chirurgical? Un rapport de cas

To report the case of a macular hole caused by a laser pointer and its management. 

Laser pointer retinal damage is increasing. Laser pointer devices are common and their easy acquisition in bazaars and on the Internet might become a serious public health issue. Retinal lesions are highly varied and their prognosis is uncertain. A laser pointer maculopathy case is reported to emphasise the difficulty in treating this pathology. 

A 14 year-old male complained of a central white dot in his right eye two months after been dancing in a disco. On examination, the visual acuity was 20/50 in the right eye and 20/25 in the left eye. Funduscopy showed a yellow spot in the foveal area. Optical Coherence Tomography revealed a total macular hole. It was 267 µm wide with intraretinal border cysts. The autofluorescence showed foveal area disturbance. Six months later, the visual acuity was 20/25 in the right eye although the width of the hole and intraretinal cysts had increased in the OCT images. A monthly follow-up was carried out. One year later, visual acuity decreased to 20/40 and the macular hole was 515 µm wide. Therefore, surgical treatment was carried out: a vitrectomy with internal limiting membrane peeling and perfluoroethane gas tamponade was performed. Three weeks later, macular hole was closed but a small retinal pigment epithelium scar persisted.

Exposure to laser pointers might generate a wide variety of retinal damage such as retinal edema, retinal pigment epithelium scars, outer retinal disruption, premacular and macular haemorrhages, epiretinal membranes, perifoveal drusens, hypopigmented foveal lesions or even traumatic macular holes. 

The severity depends on the pulse duration, the energy level and the retina location but the prognosis is uncertain. 

It is not easy to decide about the management of these patients. A several months observation period is recommended as first therapeutic strategy in all patients. Depending on visual acuity affection over time, surgical treatments might be considered: some authors recommend early surgical treatment for wide laser induced macular holes. In our clinical case, the visual acuity decreased  and the width of the macular hole increased over time so surgical treatment was carried out.

A long follow-up in all these patients and applying individualized treatments based on their visual function and OCT images evolution is necessary.

The number of children with macular damage due to the use of laser pointers is increasing. In addition, the long-term complications are not well known, so they should not be allowed to use them as toys.